Stanford Letter - Part Three

[Guest guest]

THE OPERATION:

The operation usually requires about 3 hours and most

patients can be discharged in 2-5 days. Patients with

severe lung disease may require up to several days in

the intensive care unit on a ventilator.

Complications may prolong hospitalization.

If you require the open operation, it is performed

through an upper midline incision from the xyphoid to

the navel. You are likely to have an epidural

catheter to assist with pain control, a catheter in

your bladder, and possibly a catheter through the nose

that drains the stomach.

Most patients will not require a blood transfusion,

but this is not always predictable. If you need

blood, the safest blood to receive is always your own

and we would be happy to help you arrange to donate

blood for yourself. There is no real benefit

(health-wise) to receiving blood from a friend or

relative - in general, it is not safer to receive this

blood than it is to receive it from our volunteer pool

blood bank, even if the person donating for you is a

close friend, relative or spouse.

POSTOPERATIVE CARE:

The main issue will be dietary. For the first 4 weeks

you should remain on what I call a " toothless/liquid

diet " - that is, restrict yourself only to things that

you could eat if you had no teeth. Eat slowly - at

least 30 minutes for each meal, and take frequent

pauses.

Foods that may go particularly well might include

yogurt, soups, pureed vegetables and fruits. Drink

plenty of fluids, but make sure these are non-calorie

fluids such as water, decaffeinated iced tea, diet

drinks. Stay away from carbonated beverages. It is a

good idea to drink 3-4 cups of skim milk daily - this

is an excellent source of protein with very few

calories.

When you are eating a regular diet, fiber containing

cereal or fiber supplements such as Metamucil,

Citrucel, or bran, are musts to help you get enough

roughage in your diet. You will need to continue to

eat slowly and chew your food well. You will be

required to take vitamin supplements for the rest of

your life. This will include a chewable or liquid

multi vitamin, Vitamin B12, Calcium and iron.

You will be encouraged to be as active as you can as

soon as possible. Vigorous exercise will need to

become a part of your daily routine.

WHAT TO EXPECT AFTER AN OPERATION:

Most patients are able to return to normal work levels

within 2-6 weeks of their operation. For several

weeks after the operation you may find that you tire

easily. This is normal. You may find that a daily

nap is a must - take it.

You should expect to lose no more than ten pounds per

month. Any excess weight loss during the first month

or so is due to loss of water, not lean body mass.

You will not achieve a normal weight, but most

patients lose over fifty percent of their excess

weight and can be expected to maintain most, but not

all of that weight loss when followed for several

years.

Some regain of weight happens in many patients after

about 2-3 years. Significant regain usually

represents faulty dietary habits and lack of exercise.

LONG-TERM STRATEGIES FOR MAINTAINING WEIGHT LOSS

What can you do to maintain your weight loss? A few

simple measures have been shown to matter - memorize

these and put them into action.

1. Create daily routines that make this work.

Structure your day in ways that make it impossible for

you to snack during your day. Enlist your family and

your coworkers to help you succeed. For example, show

only once a week at a large grocery store, and do that

after you have recently eaten. For fresh fruits and

vegetables go to a produce stand - someplace where

there are no chips, no ice cream, no forbidden foods.

2. Get a job that you enjoy and that keeps you busy.

One of the best predictors of how people do with these

operations is their employment history. Return to

your work as early as possible, even if it is only

part-time. If you have been on disability get off of

it; if you do not need to work for economic reasons,

become involved in a volunteer organization that is

important to you. If possible, extend your hours or

take an extra job. Look for jobs that keep you away

from food; avoid those that give you easy access to

food.

3. Exercise. This is one of the other best

predictors of a successful outcome. Exercise,

exercise, and exercise. Water sports are best,

walking is good, exercise bikes, aerobics, and weight

lifting, are all beneficial. Park your car in back

lots, far away from the office; take the stairs; grow

your own vegetables; get a dog that needs lots of

exercise. Be creative, and build this onto you

schedule.

4. Kill your TV. It turns out that one of the

predictors of how well patients do after an operation

is how much TV they watch. The less TV, the greater

the weight loss tends to be.

{That's the end of the letter}

=====

Dee

Waiting for Ins. Co. Approval

313/Want to be 165

__________________________________________________

[Guest guest]

THE OPERATION:

The operation usually requires about 3 hours and most

patients can be discharged in 2-5 days. Patients with

severe lung disease may require up to several days in

the intensive care unit on a ventilator.

Complications may prolong hospitalization.

If you require the open operation, it is performed

through an upper midline incision from the xyphoid to

the navel. You are likely to have an epidural

catheter to assist with pain control, a catheter in

your bladder, and possibly a catheter through the nose

that drains the stomach.

Most patients will not require a blood transfusion,

but this is not always predictable. If you need

blood, the safest blood to receive is always your own

and we would be happy to help you arrange to donate

blood for yourself. There is no real benefit

(health-wise) to receiving blood from a friend or

relative - in general, it is not safer to receive this

blood than it is to receive it from our volunteer pool

blood bank, even if the person donating for you is a

close friend, relative or spouse.

POSTOPERATIVE CARE:

The main issue will be dietary. For the first 4 weeks

you should remain on what I call a " toothless/liquid

diet " - that is, restrict yourself only to things that

you could eat if you had no teeth. Eat slowly - at

least 30 minutes for each meal, and take frequent

pauses.

Foods that may go particularly well might include

yogurt, soups, pureed vegetables and fruits. Drink

plenty of fluids, but make sure these are non-calorie

fluids such as water, decaffeinated iced tea, diet

drinks. Stay away from carbonated beverages. It is a

good idea to drink 3-4 cups of skim milk daily - this

is an excellent source of protein with very few

calories.

When you are eating a regular diet, fiber containing

cereal or fiber supplements such as Metamucil,

Citrucel, or bran, are musts to help you get enough

roughage in your diet. You will need to continue to

eat slowly and chew your food well. You will be

required to take vitamin supplements for the rest of

your life. This will include a chewable or liquid

multi vitamin, Vitamin B12, Calcium and iron.

You will be encouraged to be as active as you can as

soon as possible. Vigorous exercise will need to

become a part of your daily routine.

WHAT TO EXPECT AFTER AN OPERATION:

Most patients are able to return to normal work levels

within 2-6 weeks of their operation. For several

weeks after the operation you may find that you tire

easily. This is normal. You may find that a daily

nap is a must - take it.

You should expect to lose no more than ten pounds per

month. Any excess weight loss during the first month

or so is due to loss of water, not lean body mass.

You will not achieve a normal weight, but most

patients lose over fifty percent of their excess

weight and can be expected to maintain most, but not

all of that weight loss when followed for several

years.

Some regain of weight happens in many patients after

about 2-3 years. Significant regain usually

represents faulty dietary habits and lack of exercise.

LONG-TERM STRATEGIES FOR MAINTAINING WEIGHT LOSS

What can you do to maintain your weight loss? A few

simple measures have been shown to matter - memorize

these and put them into action.

1. Create daily routines that make this work.

Structure your day in ways that make it impossible for

you to snack during your day. Enlist your family and

your coworkers to help you succeed. For example, show

only once a week at a large grocery store, and do that

after you have recently eaten. For fresh fruits and

vegetables go to a produce stand - someplace where

there are no chips, no ice cream, no forbidden foods.

2. Get a job that you enjoy and that keeps you busy.

One of the best predictors of how people do with these

operations is their employment history. Return to

your work as early as possible, even if it is only

part-time. If you have been on disability get off of

it; if you do not need to work for economic reasons,

become involved in a volunteer organization that is

important to you. If possible, extend your hours or

take an extra job. Look for jobs that keep you away

from food; avoid those that give you easy access to

food.

3. Exercise. This is one of the other best

predictors of a successful outcome. Exercise,

exercise, and exercise. Water sports are best,

walking is good, exercise bikes, aerobics, and weight

lifting, are all beneficial. Park your car in back

lots, far away from the office; take the stairs; grow

your own vegetables; get a dog that needs lots of

exercise. Be creative, and build this onto you

schedule.

4. Kill your TV. It turns out that one of the

predictors of how well patients do after an operation

is how much TV they watch. The less TV, the greater

the weight loss tends to be.

{That's the end of the letter}

=====

Dee

Waiting for Ins. Co. Approval

313/Want to be 165

__________________________________________________

[Guest guest]

At 07:390 -0700 8/21/01, Dee wrote:

>Some regain of weight happens in many patients after

>about 2-3 years. Significant regain usually

>represents faulty dietary habits and lack of exercise.

hey look! they are giving themselves an out before you even sign on

with them! If you regain, IT'S ALL YOUR FAULT!!! Not the procedure's,

not the surgeon's, not the clinic's -- it's ALL YOURS. Man, more

guilt I do not need!

--stella

[Guest guest]

At 07:390 -0700 8/21/01, Dee wrote:

>Some regain of weight happens in many patients after

>about 2-3 years. Significant regain usually

>represents faulty dietary habits and lack of exercise.

hey look! they are giving themselves an out before you even sign on

with them! If you regain, IT'S ALL YOUR FAULT!!! Not the procedure's,

not the surgeon's, not the clinic's -- it's ALL YOURS. Man, more

guilt I do not need!

--stella